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Titolo Optimizing the dialysate calcium concentration in bicarbonate haemodialysis
Autore Gianmario Bosticardo1, Fabio Malberti2, Carlo Basile3, Loretta Leardini4, Pasquale Libutti3, Oliviero Filiberti5, Enrico Schillaci1 and Pietro Ravani6 1Hospital-Territory Department, Nephrology and Dialysis Unit, Ospedale degli Infermi, Biella, Italy, 2Department of General and Specialistic Medicine, Nephrology and Dialysis Unit, Istituti Ospedalieri, Cremona, Italy, 3Department of Medicine, Nephrology and Dialysis Unit, Ospedale Miulli, Acquaviva delle Fonti, Bari, Italy, 4Services Department, Transfusion Unit, Ospedale degli Infermi, Biella, Italy, 5Medical Area Department, Nephrology and Dialysis Unit, Ospedale S. Andrea, Vercelli, Italy and 6Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada
Referenza Nephrol Dial Transplant 2012; doi: 10.1093/ndt/gfr733

Background. There is no consensus regarding the optimal dialysate calcium concentration (DCa) during haemodialysis (HD). Low DCa may predispose to acute arrhythmias, whereas high DCa increases the long-term risk of soft tissue calcifications.

Methods. Twenty-two HD patients treated in four dialysis centres underwent two HD sessions, respectively, with 1.5 and 1.25 mmol/L total DCa. Calcium mass balance (CMB) was calculated from ionized calcium (iCa) in the dialysate and blood at the start and end of each run, using a kinetic

formula to define the mean concentrations in the blood and dialysate and then estimating CMBs over the entire treatments.

Results. Mean blood iCa levels increased using 1.5 DCa, whereas they remained unchanged using 1.25 DCa. Diffusive CMB positively correlated with the dialysate/blood iCa gradient. With 1.5 DCa, diffusive CMBs were strongly positive at the blood side and negative at the dialysate side, indicating transfer from dialysate to blood. With 1.25 DCa,

despite a negative dialysate/blood iCa gradient, diffusive CMB was slightly positive in blood and negative in dialysate. The global balances based on both the convective and diffusive components showed a positive net transfer of Ca from dialysate to blood with 1.5 DCa and an approximately neutral Ca flux with 1.25 DCa. Conclusions. While CMB is nearly neutral when using 1.25 DCa, the use of 1.5 DCa results in a gain of Ca during HD. The risks associated with Ca load should be considered in the choice of DCa prescription for HD but need also be weighed against the risk of worse haemodynamic dialysis tolerance.

Data 05.03.2012
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